Provider Demographics
NPI:1104278043
Name:ARNOLD, AMANDA KAYE (MSPAS, RDN, PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MSPAS, RDN, PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAYE
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 SE HOSPITAL AVE # 2346
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2346
Mailing Address - Country:US
Mailing Address - Phone:216-490-4865
Mailing Address - Fax:
Practice Address - Street 1:3801 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4801
Practice Address - Country:US
Practice Address - Phone:772-221-2003
Practice Address - Fax:772-288-5835
Is Sole Proprietor?:No
Enumeration Date:2016-07-03
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
FLPA9119077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered